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Published on: August 28, 2018
Non-invasive diagnosis of coronary artery disease with 16-slice computed tomography
Gurpreet Singh Gulati1, Sandeep Seth, Sumodh Kurian
1Cardiothoracic Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029. gulatigurpreet@rediffmail.com
Insights
Multislice computed tomography (MSCT) shows promise for diagnosing coronary artery disease (CAD) by effectively ruling out the condition. This non-invasive method also accurately identifies coronary anomalies.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Coronary artery disease (CAD) diagnosis traditionally relies on invasive catheter angiography.
- Catheter angiography may not always lead to immediate interventional therapy.
- Multislice computed tomography (MSCT) offers a non-invasive alternative for CAD diagnosis.
Purpose of the Study:
- To evaluate the diagnostic accuracy of 16-slice MSCT for detecting obstructive CAD.
- To compare MSCT with catheter angiography in patients with suspected CAD.
- To assess the correlation between calcium score and obstructive CAD, and the impact of heart rate on image quality.
Main Methods:
- Thirty-one patients underwent both 16-slice MSCT and catheter angiography.
- Analysis focused on vessel segments with diameters greater than 1.5 mm.
- MSCT's ability to detect stenosis (> or =50% diameter reduction) was evaluated.
Main Results:
- MSCT demonstrated high sensitivity (85%) and specificity (94%) for detecting obstructive CAD.
- The negative predictive value of MSCT was 96%, indicating its strength in excluding CAD.
- MSCT correctly classified overall disease severity in 87% of cases and accurately identified coronary anomalies.
Conclusions:
- MSCT is a valuable non-invasive tool for diagnosing coronary stenosis, particularly for excluding CAD.
- Its high negative predictive value makes it suitable for ruling out the disease.
- MSCT accurately visualizes coronary anomalies.
Background:
The gold standard for the diagnosis of coronary artery disease (CAD) is catheter angiography. However, catheter angiography is invasive and may not always be followed by interventional therapy. We report our results with the use of multislice computed tomography (MSCT) as a non-invasive diagnostic tool for CAD.
Methods:
Thirty-one patients (26 with chronic stable angina, 5 with coronary anomalies) underwent 16-slice MSCT and catheter angiography. Vessels < 1.5 mm in diameter were excluded. The ability of MSCT to detect obstructive CAD (stenosis > or =50% of the diameter) was evaluated in pre-defined vessel segments. The association of calcium score with obstructive CAD, and the effect of heart rate on distal vessel visibility were also studied.
Results:
There were 29 men and 2 women (age range: 36-80 years; mean [SD]: 53 [11] years). Of the 403 vessel segments, 391 were > 1.5 mm in diameter and 321 were interpretable on both modalities. The non-interpretability rates were 7% (26/391) for catheter angiography and 14% (54/ 391) for MSCT, with distal location (64%; 34), motion artifacts (29%; 16) and calcification (7%; 4) being chiefly responsible in case of the latter technique. The sensitivity, specificity, positive and negative predictive values of MSCT were 85% (95% confidence interval [CI]: 73-93), 94% (95% CI: 90-96), 76% (95% CI: 64-85) and 96% (95% CI: 93-98), respectively. MSCT correctly classified patients with no, single-, double- and triple-vessel disease in 87% of cases. One patient was incorrectly excluded on MSCT; catheter angiography showed 50%-70% stenosis in this case. Patients with obstructive CAD had a higher Agatston score equivalent (p=0.03). There was no significant effect of heart rate on distal segment visibility. MSCT correctly identified all coronary anomalies.
Conclusion:
MSCT has a good potential for the detection of coronary stenosis, and may be most useful for excluding CAD (due to its high negative predictive value). It accurately delineates coronary anomalies.
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